Lower anterior resection

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Lower anterior resection

A lower anterior resection, formally known as anterior resection of the rectum and anterior excision of the rectum or simply anterior resection (less precise), is a common surgery for rectal cancer and occasionally is performed to remove a diseased or ruptured portion of the intestine in cases of diverticulitis. It is commonly abbreviated as LAR.

LARs are for cancer in the proximal (upper) two-thirds of the rectum which lends itself well to resection while leaving the rectal sphincter intact.[1]

Relation to abdominoperineal resection[edit]

LARs, generally, give a better quality of life than abdominoperineal resections (APRs).[2][3] Thus, LARs are generally the preferred treatment for rectal cancer insofar as this is surgically feasible. APRs lead to a permanent colostomy and do not spare the sphincters.

Low Anterior Resection Syndrome[edit]

Low anterior resection syndrome (LARS) comprises a collection of symptoms mainly affecting patients after surgery for rectal cancer characterized by fecal incontinence (stool and gases), fecal urgency, frequent bowel movements and bowel fragmentation. These symptoms have a major impact on the quality of life of patients and several studies have tried to establish the prevalence and severity of this syndrome as well as its correlation with epidemiological factors. So far, neoadjuvant therapy for rectal cancer, total versus partial mesorectal excision, patient age <64, anastomotic leak and female sex have been identified as predisposing factors for severity and duration of LARS symptoms. Presence of ileostomy or time to ileostomy closure is not associated with the development of this syndrome.[4]

Many of the symptoms of LAR Syndrome improve over a period of many months.[5] The nerves that control the natural contractions of the colon and rectum run along the colon and can be damaged or cut during the surgery.[6] After such damage, the nerves can regrow, but only slowly.

References[edit]

  1. ^ "Detailed Guide: Colon and Rectum Cancer". American Cancer Society. Retrieved February 5, 2008. 
  2. ^ McLeod RS (2001). "Comparison of quality of life in patients undergoing abdominoperineal extirpation or anterior resection for rectal cancer". Ann. Surg. 233 (2): 157–8. PMC 1421195Freely accessible. PMID 11176119. doi:10.1097/00000658-200102000-00002. 
  3. ^ Grumann MM, Noack EM, Hoffmann IA, Schlag PM (2001). "Comparison of quality of life in patients undergoing abdominoperineal extirpation or anterior resection for rectal cancer". Ann. Surg. 233 (2): 149–56. PMC 1421194Freely accessible. PMID 11176118. doi:10.1097/00000658-200102000-00001. 
  4. ^ Jiménez-Rodríguez, R. M.; Segura-Sampedro, J. J.; Rivero-Belenchón, I.; Díaz Pavón, J. M.; García Cabrera, A. M.; Vazquez Monchul, J. M.; Padillo, J.; de la Portilla, F. (2017-05-01). "Is the interval from surgery to ileostomy closure a risk factor for low anterior resection syndrome?". Colorectal Disease: The Official Journal of the Association of Coloproctology of Great Britain and Ireland. 19 (5): 485–490. ISSN 1463-1318. PMID 27634544. doi:10.1111/codi.13524. 
  5. ^ Professor Filippo Pucciani, MD (2009). "Anterior Resection Syndrome" (PDF). Società Italiana di Chirurgia ColoRettale. 24: 211–217. These symptoms improve with time and most patients can enjoy almost normal daily life by the sixth postoperative month. 
  6. ^ Eberhard Gross (2011). "Causes and Prevention of Functional Disturbances Following Low Anterior Resection for Rectal Cancer". In Dr. Giulio A. Santoro. Rectal Cancer - A Multidisciplinary Approach to Management (PDF). InTech. ISBN 978-953-307-758-1. dysfunctions such as anal continence disorders occur in quite a few patients following anterior resection, ... and disorders of the bladder and sexual function can occur because the autonomic nerves, which regulate bladder and sexual function as well as anal continence, are often damaged due to their anatomical proximity. 

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